USA Today Examines NIH Report On Nonsurgical Incontinence Treatments

Main Category: Women's Health / Gynecology
Also Included In: Urology / Nephrology;  Rehabilitation / Physical Therapy
Article Date: 07 Jun 2008 - 0:00 PDT

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USA Today on Thursday examined the latest advice for women experiencing incontinence, including an NIH "state-of-the-science" report published in March in the Annals of Internal Medicine on nonsurgical treatments. The report looked at nearly 100 clinical trials and three comprehensive reviews of incontinence treatments.

According to USA Today, about 20% to 30% of women experience incontinence. Fewer than half of women with the condition seek treatment because they are embarrassed or do not realize treatment is available, Diane Newman, a nurse practitioner at the University of Pennsylvania, said. Newman added that although surgery is effective for up to 90% of women, it increases the risk of side effects, such as bleeding. In addition, some women who have surgery develop other problems, such as more frequent urination.

According to the NIH report, the most effective nonsurgical treatment is a type of physical therapy called pelvic floor muscle training. The training includes Kegel exercises, which strengthen the muscles surrounding the urethra that control urination. Pelvic floor muscle training cures about half of women with stress incontinence, in which urine leaks during sneezing or coughing. The training can be more effective when combined with biofeedback sensors, which are attached to the pelvic floor and allow women to watch their muscles working on a computer.

Other treatments examined by NIH include bladder training -- in which women go to the bathroom on a schedule -- and pelvic exercises. In addition, the medications Detrol and Ditropan, as well as estrogen patches and gels, can alleviate incontinence, USA Today reports. Robert Kane, a co-author of the report and a geriatrician and epidemiologist at the University of Minnesota School of Public Health, recommends pelvic exercises for women at high risk of incontinence, including women who leaked urine during pregnancy, who delivered with the use of forceps and who have had a hysterectomy or other pelvic surgery. Kane said that about half of women who experience incontinence during pregnancy or postpartum improve without treatment.

Kane said that there is no evidence that women who have caesarean deliveries have a lower risk of incontinence than those who deliver vaginally. In addition, there is no evidence that the condition is more common in women who have had several children. Elderly women who have not had children are as likely to experience incontinence as those who have had children, USA Today reports. The report notes that hormone pills have been found to increase risk of incontinence. Kane said researchers do not know why the pills increase risk (Szabo, USA Today, 6/5).

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